Healthcare Provider Details

I. General information

NPI: 1376504357
Provider Name (Legal Business Name): STEPHANIE L GREEN CFNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: STEPHANIE L PEARCE

II. Dates (important events)

Enumeration Date: 03/30/2006
Last Update Date: 06/10/2026
Certification Date: 06/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1911 READ RD
PICAYUNE MS
39466-2730
US

IV. Provider business mailing address

PO BOX 1729 108
HATTIESBURG MS
39403-1729
US

V. Phone/Fax

Practice location:
  • Phone: 601-251-3500
  • Fax:
Mailing address:
  • Phone: 601-545-8700
  • Fax: 601-255-2645

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number804976
License Number StateMS
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number2066
License Number StateNE
# 3
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPN.0992934-NP
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: